CAR T-Cell Therapy Moves Earlier in Relapsed/Refractory Multiple Myeloma
Key Points
- Chimeric antigen receptor (CAR) T-cell therapy, particularly ciltacabtagene autoleucel (cilta-cel), is moving earlier in the multiple myeloma treatment paradigm after showing significant survival benefits in CARTITUDE trials.
- Achieving disease control with bridging therapy before CAR T infusion improves outcomes and reduces toxicity, supporting its use as a consolidation strategy rather than salvage.
- Early referral for CAR T evaluation is critical, as delays or multiple prior therapies may limit patient eligibility.
In a recent Clinical Insights discussion, coinciding with the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, Oncology Brothers podcast cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, welcomed Ajai Chari, MD, of University of California, San Francisco Health; Binod Dhakal, MD, of the Medical College of Wisconsin; and Surbhi Sidana, MD, of Stanford University. The experts discussed how CAR T-cell therapy is reshaping the treatment landscape for patients with relapsed or refractory multiple myeloma.
Dr. Chari highlighted the use of cilta-cel, a B-cell maturation antigen (BCMA)–directed CAR T-cell therapy, which received FDA approval based on the CARTITUDE-1 trial in heavily pretreated patients. CARTITUDE-4 data showed that cilta-cel significantly improved progression-free survival, with an approximately 75% risk reduction compared with standard-of-care regimens, as well as an overall survival benefit, leading to approval in the second-line setting.
Data presented at ASCO 2026 emphasized the role of bridging therapy before CAR T administration. Patients who achieve at least a partial response prior to infusion have improved outcomes and lower rates of severe toxicity, regardless of risk status. Therefore, the experts agreed that CAR T should be used as a consolidation strategy rather than a salvage or debulking approach.
Dr. Dhakal stressed the importance of early referral for CAR T evaluation, explaining that delays or use of multiple interim therapies may compromise eligibility.